Lumbar Spine Assessment Flashcards
Fryette’s law
- in neutral SB opposite to rotation
- In felxion/extension SB same side as rotation
- movement in 1 plane decreases movement in others
type 1 dysfunction
found in neutral position
multi segment >3
adaptive : repetitive mvt, imbalances, tightness
corrected in both flex or ext
type 2 dysfunction
1 segment
traumatic
likes flex FRS
likes ext ERS
corrected in what they like
facet info with law 1 and 2
same facet as side bend is closed
how common is low back pain
80%
what can influence the onset of LBP
environmental and personal factors
psychosocial causes
risk factors for LBP (psychosocial) (6)
low educational status
stress
anxiety
depression
job dissatisfaction
low levels of social support in the workplace
most common form of back pain
non-specific
several structures can be the cause of the pain
true
history taking for LBP should include
questions on substance exposure
detailed health history
work
habits
psychosocial factors
is it recommended to do imaging within the first 6 weeks
no unless red flags
Lumbar spine pathologies
Stenosis
spondylosis
spondylolisis
ankylosing spondylitis
biomechanical restrictions
stenosis
narrowing of vertebral space
Better with flexion
spondylosis (DDD)
begins in 20’s
overall OA and stenosis
age related wear and tear
spondylolisis
90% at L5/S1
excessive lordosis
posturale ache
tight psoas and hamstrings
stress fx or complete fx
ankylosing spondylitis
inflammatory disorder of spine
morning stiffness
pain with exercise
leading to decrease vertebral movement, bones of spine can fuse
radicular pain
evoked from inflamed or lesioned dorsal root or its ganglion
radicular pain location
often back to butt down legs
most common cause of radicular pain
disc herniation
radiculopathy
impairs the conduction down a spinal nerve or its root
radiculopathy affects
sensory changes, motor fibers, and possible reflexes
can radicular pain occur without radiculopathy
yes
most common disc pathology
posterior disc herniation
Facet joints
large amount of free and encapsulated nerve endings that activate nociceptive fibers
Can be a cause of CLBP
facet joint syndrome
responsible for up to 30% of chronic low back pain
common complaints of facet joint syndrome
pain off to the side
possible radicular symptoms
pain increased with extension, rotation and SB and walking uphill
worse when waking up or sitting for long periods
cause of stenosis
inflammatory/scar tissue after spine surgery
disc herniation
thickening of ligaments
osteophytes
common S/S of stenosis
midline back pain
radiculopathy
eased with flexion sitting lying
worse standing lumbar extension
what can increase risk of DDD
diabetes
S/S of spondylosis
general neck pain and stiffness
can be associated with radiculopathy
spondylolisthesis
anterior translation of the vertebral body relative to the other, and secondary to an abnormality of the pars interarticularis
chief complaints of spondylolisthesis
can be asymptomatic
gradual onset that is worsened with activity involving hyperextension or rotation of L/S
radiculopathy can occur
spondylolisthesis can affect load sharing
inc shearing forces
higher sacral slope, pelvic tilt
inc pressure on discs, facet joints, leading to DD
muscle spasm of ES to protect
differential diagnosis
how do postural muscles react to injury
tightness in the form of spasms or adaptive shortening
how do phasic muscles react to injury
atrophy
difficulty sitting associated with
lumbar instability or muscle spasm
discogenic pain
flexion for extended periods of time
special tests for L/S (11)
SLR (1-5)
Slump
corssover sign/well leg raise (SLR 5)
PKB
valsalva
quadrant test
stork
mckenzie side glide
pheasant
passive lumbar extension
H and I
Pain in back with SLR
most likely from disc herniation
pain in leg with SLR
pathology causing pressure on neurological tissues more laterally
SLR 1 nerve
sciatic and tibial
SLR 2 nerve
tibial
SLR 3 nerve
sural
SLR4 nerve
common peroneal
SLR 5 nerve
nerve root
